Access barriers to in vitro diagnostics in Cambodia, Indonesia, Lao PDR, and the Philippines: programmatic lessons from NEDL field missions

BACKGROUND: Access to essential in vitro diagnostics (IVDs) remains limited in many low- and middle-income countries, where persistent challenges exist in financing, human resources, infrastructure, procurement, supply chain management, and health insurance arrangements. Despite growing regional initiatives, such as the Association of Southeast Asian Nations (ASEAN) Essential Diagnostics List Initiative, country-specific evidence on barriers to IVD access remains limited. This article summarizes barriers to accessing IVDs and related lessons identified from field missions conducted as part of a technical cooperation project supporting the development of the National Essential Diagnostics Lists (NEDLs) in Cambodia, Indonesia, Lao PDR, and the Philippines. METHODS: Field missions were conducted in the four countries between December 2024 and May 2025. Mission reports and interview records derived from key informant interviews with government officials and health workers from ministries of health, health facilities, local health offices, and health insurance agencies were examined. Statements related to potential barriers to accessing IVDs were coded, and emergent concepts were organized into a thematic framework consisting of domains and key access barriers. RESULTS: Seventeen barriers to IVD access were identified across six domains (resources; procurement and supply chain; equipment maintenance; documented rules and standards; health insurance coverage; and attitudes of service recipients). Resource constraints, including limited budgets, workforce shortages, and inadequate laboratory infrastructure, were widespread. Procurement and supply chain challenges-such as weak demand forecasting, limited supplier availability, and logistical constraints-frequently resulted in stockouts. An important operational insight was that delays in health insurance reimbursement disrupted supplier payments and contributed to stockouts. Additional barriers included limited equipment maintenance capacity, gaps in guidelines and regulations, insufficient insurance coverage, and demand-side constraints such as low awareness and trust in diagnostic tests. CONCLUSIONS: Access to IVDs in the four ASEAN countries is constrained by multifaceted health system barriers. This study highlights an underrecognized mechanism-insurance reimbursement delays leading to stockouts-that warrants policy attention in the Asian context. As countries progress from the NEDL development to implementation, the six-domain, 17-barrier framework offers a practical tool for identifying system bottlenecks and guiding targeted interventions to ensure equitable access to essential IVDs.